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by Amanda Conschafter, blog editor

Clinical practice guidelines are intended to optimize patient care, explains a new policy brief from the Institute for Patient Access. But those guidelines must permit flexibility in physicians’ care of individual patients. And when guidelines’ formulation diverges from established standards for transparent, informed and evidence-based advice, controversy can ensue.

The number of available medical guidelines now tops 2,700. Put forth by medical professional societies, government institutions and health insurance organizations, some of these guidelines may be contradictory – or even untrustworthy. To help physicians and patients gauge the validity of individual guidelines, the Institute of Medicine developed standards in 2011.

Unfortunately, not all organizations that develop guidelines adhere to these standards.

Transparency, for example, is a standard acknowledged by IOM. But its use is not universal. For example, some questioned the Centers for Disease Control and Prevention’s process for selecting the committee to develop their recent guidelines on opioid treatment for chronic pain. In response to public outcry, the CDC broadened its request for input to include professional medical organizations, community groups, and the public.

IOM also outlines the importance of disclosure and managing conflicts of interest. The most knowledgeable and relevant experts may have conflicts of interest, such as physicians who practice medicine in the area described in the guideline. Often, it is important to include these individuals despite their potential conflicts of interest.

Despite best efforts, the evidence base for some guidelines is incomplete, allowing for multiple interpretations. An example of this is in the 2014 revised guidelines issued by the American Academy of Pediatrics Committee on Infectious Diseases for the use of a prophylactic medication for respiratory syncytial virus. The revised guidelines, the policy brief explains, have been criticized for the data utilized to support its conclusions. 

Although it can sometimes be challenging, efforts to involve patients in the development of guidelines have been successfully implemented. Without patient involvement, health insurers may weigh cost too heavily and government organizations may develop guidelines that lack the patient perspective.

Clinical practice guidelines can be extremely useful, the policy paper concludes, but they were never intended as absolutes. For best results, guidelines should adhere to established IOM standards and physicians should maintain the latitude to provide individualized patient care that reflects their professional judgment.

To learn more, read “Clinical Practice Guidelines and Patient Access.”

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